Medical Claims Adjudication Services
Home » Medical Claims Adjudication Services

Medical Claims Adjudication Services

Medical Claims Adjudication Services

Healthcare industry is currently one of the fastest growing industries in India and abroad. And rightly so, since everyone associated with the healthcare sector from health insurance companies to pharmaceutical firms to hospitals and care facilities experiences an all-time growth along with an increased interest in their products and services.
The growth of these companies will be followed by an increase in demand to hire a large pool of staff, one that can take care of other mundane tasks such as data entry, medical claims adjudication, and processing. Hiring that big a staff will eventually take its toll on both the staff members and the overall budget of the medical businesses itself.

The Solution?

Octopus Tech’s wide range of healthcare services, your one-stop destination. We cover everything, among which the primary ones are medical claim processing and adjudication solutions, build specifically to help you provide quality and value to your clients. How?
The key lies in our proprietary workflow technology which combined with our skilled adjudicators and automated audit processes not only help increase processing quality and accuracy but also reduce TAT (turnaround time) and backlogs, that too without any additional capital requirement.
The end result? An increased client satisfaction emerging from claims processing to final adjudication and payment, all this without burning a hole your pockets. Yes, you can achieve all this by hiring us. We are a team of skilled adjudicators who knows our path well around optimizing existing procedures, automating analysis, and applying a secure digital workflow. Let’s go through our inner processes to gain a better understanding.

Our Medical Claim Adjudication Process

We at Octopus Tech takes an expert, well-structured and comprehensive approach to the claims adjudication process. All thanks to our thorough experience in many different industries including all aspects of business process outsourcing that has helped us develop an exemplary set of practices to conduct our day-to-day business operations.

  • We begin by receiving claims data from you thereupon which it is reviewed closely by our analysts who check for any errors (a major cause for claim rejection) such as incorrect patient names, ID info, service codes etc.
  • After the initial review, the claims are further examined by our expert team of healthcare professionals who check for the authenticity of the claims by matching them with the medical records and other relevant documents.
  • We do a third in-depth check of the claims, this time in accordance with the payer’s payment policies. This is the final step before forwarding your medical claim to the insurance companies.
  • Calculations are done at this stage to determine the valid data amount. Here, either the claims will be settled in full or can be denied by the insurance payers. Or they might also be reduced if the billing amount is considered too high as per the diagnosis.
  • This is the last stage where we submit the released payment to the relevant office along with providing the break-down details of the payment approved. We also explain the reasons (for future use) as to why the reductions or denials were made.
Octopus Tech: Not your typical outsourcing company

Why so? Because we understand the importance of claims adjudication services and its after effect on the medical claims processing for your practice. That’s why we have an experienced and certified team of claim adjudicators who are dedicated to provide you the best outsourcing adjudication services there are to avail. We have everything at our disposal to handle your claims adjudication needs in a professional manner.

Contact Octopus Tech today to discuss your claims adjudications services and requirements with us.

    YesNo
    captcha